In the case of a burn, the effects of heat lead to subsequent tissue damage. The skin is most frequently affected by a burn, as it acts as the protective layer of the entire body and is therefore most likely to be affected by hot objects (or the sun). Mucous membranes can also be affected by a burn, for example when drinking hot liquids or swallowing hot objects (sword swallowers).
The skin is the largest human organ and usually covers an area of up to two square meters. Depending on the body region and pressure load, the thickness of the skin can be between half a millimeter and five millimeters. While it is particularly robust on the soles of the feet and palms of the hands, it can be paper-thin in other areas.
The skin is made up of two main layers:
- Cutis
- Subcutis
The upper layer of skin is the cutis. This is further divided into the outer epidermis and the underlying dermis, also known as the corium or dermis. The lower layer of skin is known as the subcutis and consists of fatty tissue with blood vessels running through it.
A burn is generally a very serious condition that not only affects the skin, but the entire organism. This is why it is often referred to as a burn disease. The greater the proportion of burnt skin and the deeper the skin damage reaches into the tissue, the more serious the burn disease that can be observed. In addition, the skin has a heat storage effect and the full extent of the burn usually only really becomes visible after a few hours. An example of this is sunburn, where the full extent of the burn often only becomes visible and noticeable in the evening after exposure to the sun.
The severity of a burn depends on the temperature and the duration of exposure to the heat. The decisive factor here is the depth of the tissue damage. Depending on the degree of damage, doctors speak of first to fourth degree burns:
- 1st degree - The damage is limited to the epidermis, the burn usually heals without complications.
- 2nd degree - The burn penetrates into the dermis and blistering typically occurs. Scars and pigmentation disorders are possible during the healing process.
- 3rd degree - The entire epidermis is affected and the damage extends into the subcutis. This often leads to damage to skin nerves, which is why patients do not experience any pain. Even if it is beneficial for those affected at this moment, the lack of pain is indicative of extensive tissue damage. In the course of recovery, the skin forms deep scars, which often become a case for plastic/aesthetic surgery.
- 4th degree - All layers of the skin are charred, the damage also includes the tissue under the skin with tendons, joints and bones. This can result in amputation of the affected body part.
The burn grades are used for the clinical classification of a burn based on the depth of the skin damage @ designua /AdobeStock
What does the so-called rule of nine mean?
Doctors use the rule of nine to assess the extent of the burn. This divides the body into areas that each take up around 9 percent or a multiple (18 percent, 36 percent) of the skin area:
- head/neck and each arm 9 percent each
- each leg 18 percent
- trunk 36 percent
- 1 percent on the palms of the hands and the genital area
If more than 15 percent of the skin surface is burned, the injury is considered life-threatening in adults; in children, 10 percent or even less is sufficient. If the burn is accompanied by inhalation trauma, the percentage is halved.
What is inhalation trauma?
Doctors speak of inhalation trauma when the heat enters the airways through inhalation and causes further burns. This is most commonly caused by smoke, for example when it is not immediately possible to escape from a burning house or car. Inhalation trauma is a very serious condition that generally requires intensive medical monitoring. The lungs are the main organ damaged, but here too a burn disease is caused by the absorption of toxins and impaired lung function after the trauma.
Most burns occur in the home or during leisure activities. Only about one in five heat-related skin injuries occur at work. The causes vary:
- Flames, open fire, explosion (classic burns)
- hot liquids (scalding)
- hot objects (contact burns)
- Concrete or cement, solvents or cleaning agents (chemical burns)
- Sun, exposure to X-rays and UV rays (radiation burns)
- Electric current, lightning (electrical combustion)
How can a burn be prevented?
Burns can be prevented in everyday life by being more careful. The risk of injury is particularly high for small children. In their urge to explore, children are quick to snatch hot drinks from the table or open oven doors. Special attention and the installation of safety locks or oven guards can prevent accidents. Adults should take particular care when barbecuing.
The symptoms of a burn depend on the degree of the burn. The deeper the injury, the less pain is felt.
- A 1st degree burn leads to symptoms such as redness, swelling, pain and a feeling of tightness in the skin.
- In the case of 2nd degree burns, both the epidermis and dermis are damaged. The consequences are redness, blistering, a weeping surface and pain. The deeper and more extensive the burn is, the less painful the symptoms will be. This is due to the fact that deep burns also cause damage to the sensory nerve endings (which transmit pain).
- In the 3rd degree, all skin layers are already affected. The wound is charred white to black and dry. The patient feels little or no pain.
- The 4th degree burn is also known as charring. In addition to the skin, bones, muscles and tendons are affected. The wound is black in color and the burn is not associated with pain due to the destruction of the nerve endings.
How does the burn disease manifest itself?
Severe burns usually have consequences for the entire organism. The patient loses proteins and body fluids through the wound, which leads to a lack of oxygen and impaired blood circulation. Dizziness or loss of consciousness can occur, as can burn shock. Blood pressure drops, the heart beats conspicuously fast, the arms and legs become cold and pale and metabolic disorders occur. In the worst case, there is a risk of organ failure. Inhalation trauma also has a negative effect on the prognosis. Difficulty breathing, hoarseness or coughing up soot indicate damage to the airways.
2nd degree burns heal within 1-2 weeks @ lapis2380 /AdobeStock
As with all accidents, proper first aid is of great importance for burns. The first step is to rescue the victim and remove the source of heat. Burnt clothing should initially be left on the body. In the case of severe and extensive burns, the first aider must inform the emergency doctor immediately. The injured person must be kept warm until they arrive. Ideally, a rescue blanket with the silver side facing inwards should be used as a base.
- In the case of a small 1st degree burn, a doctor is usually not required. In this case, the wound should be kept under cool, running water. However, the temperature should not fall below 20 degrees Celsius, otherwise there is a risk of hypothermia. A maximum duration of 20 minutes is recommended. Cooling gels or compresses are then applied.
- Second-degree burns with blistering can be shown to the doctor after initial treatment. The doctor will clean the wound and open the blisters under sterile conditions.
- Third-degree burns always require a visit to the doctor, in most cases even inpatient treatment in a burns clinic. There are clinics specializing in burns (burn clinics) for this purpose.
- In the case of fourth-degree burns or extensive burns (including first-degree burns) and in the case of suspected or confirmed inhalation trauma, the emergency doctor should always be called due to the risk of circulatory shock.
Patients with deep burns usually have a long road to recovery ahead of them. After the initial treatment of the wound, it is important to prevent infection. The plastic surgeons then come into play. The dead skin is removed and replaced with a skin graft. This is preferably taken from healthy areas of the patient's skin. In particularly severe cases, when bones and joints are also charred, it may be necessary to amputate the affected part of the body.
